Apixaban (Brand name: Eliquis) is a drug prescribed for stroke and blood clots, in patients with atrial fibrillation (Nlm.nih.gov, 2016). It is an inhibitor of blood clotting factor Xa (Nlm.nih.gov, 2016). Adherence to medication is prescribed in the high risk population and the drug should not be discontinued without the doctor’s advice, even after the patient begins to feel healthy. Two oral doses of the drug daily, are prescribed. An occasional missed dose is allowed. Adherence to the medication on all consecutive days is expected (Helfand, 2015). The drug is taken orally and is absorbed in the stomach and small intestine (Drugbank.ca, 2016). The bioavailability of the drug is 50% and it takes 3-4 hours for the drug to reach maximum concentration in the blood (Drugbank.ca, 2016).
The drug is metabolized in the liver. O-Demethyl apixaban sulfate is the major drug metabolite in the plasma. Other post metabolic pathways that cause O-demethylation, hydroxylation and sulfation of O-demethyl apixaban are also identified in the body. Feces is the predominant (50% of the absorbed drug) excretory route of the drug. The drug is also excreted (20-30% of the absorbed dose) to some extent in the urine. (Raghavan et al., 2008)
Easy bruising, bleeding (especially from the nose and gums) and nausea, are common side effects seen with the drug. Pain, swelling and other discomforts are also reported in prolonged usage. The physician needs to be informed if the symptoms persist for long. Modifications in dose are done to ameliorate side effects (WebMD, 2016). Apixaban acts by inhibiting the clotting factors, thereby prolonging the prothrombin time and activated partial thromboplastin time (aPTT). High degree of dose variability is observed based on the individual’s health and wellbeing. A regular monitoring will be required to assess drug dose and action. The drug is superior to warfarin as it has less adverse episodes when compared to the former. (Raghavan et al., 2008)
References:
WebMD. (2016). apixaban oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD. [online] Available at: http://www.webmd.com/drugs/2/drug-163069/apixaban- oral/details#side-effects [Accessed 8 May 2016].
Nlm.nih.gov. (2016). Apixaban: MedlinePlus Drug Information. [online] Available at: https://www.nlm.nih.gov/medlineplus/druginfo/meds/a613032.html [Accessed 8 May 2016].
Drugbank.ca. (2016). DrugBank: Apixaban. [online] Available at: http://www.drugbank.ca/drugs/DB06605 [Accessed 8 May 2016].
Helfand, C. (2015). Patient Education Does Not Impact Apixaban Adherence | FiercePharma. [online] Fiercepharma.com. Available at: http://www.fiercepharma.com/pharma/patient- education-does-not-impact-apixaban-adherence [Accessed 8 May 2016].
Raghavan, N., Frost, C., Yu, Z., He, K., Zhang, H., Humphreys, W., Pinto, D., Chen, S., Bonacorsi, S., Wong, P. and Zhang, D. (2008). Apixaban Metabolism and Pharmacokinetics after Oral Administration to Humans. Drug Metabolism and Disposition, 37(1), pp.74-81.
